PATIENT SAFETY AND QUALITY IMPROVEMENT IN EMERGENCY MEDICAL SERVICES: CURRENT PRACTICES AND FUTURE DIRECTIONS
Main Article Content
Keywords
Emergency Medical Services, patient safety, quality improvement, telemedicine, data-driven approaches, AI in healthcare
Abstract
To prevent unfavorable events during prehospital treatment, emergency medical services (EMS) implement several patient safety-focused actions and procedures. Influential reports and technology that have always been interested in improving the quality of care have caused this profession to undergo many changes. This review intends to explain the current state of patient safety in EMS, quality improvement activities, and the future outlook. It comprises information from the national and state standards, protocols, and guidelines such as the ‘EMS Agenda for the Future’, CQI models, and case studies. Today’s practices are focused on training, technology, and quality improvement where technologies like EHRs, telemedicine, and decision support systems improve patient care. However, challenges such as human resource constraints, communication breakdown, and regulatory concerns are still present. The main directions for the further enhancement of safety and quality in the future are the use of data and patient-oriented care. The review also identifies the areas that need improvement and innovation, where the future research directions show the use of new technologies such as artificial intelligence and machine learning, changes in the legal requirements, and the use of international standards. Further research is needed to define the concept of patient-oriented care in emergency medical services and evaluate the effectiveness of safety interventions.
References
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6. Hunt DF, Bailey J, Lennox BR, Crofts M, Vincent C. Enhancing psychological safety in mental health services. International journal of mental health systems. 2021 Dec;15:1-8.
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8. Weaver MD, Wang HE, Fairbanks RJ, Patterson D. The association between EMS workplace safety culture and safety outcomes. Prehospital emergency care. 2012 Jan 1;16(1):43-52.
9. Carne B, Kennedy M, Gray T. Crisis resource management in emergency medicine. Emergency Medicine Australasia. 2012 Feb;24(1):7-13.
10. Chen C, Kan T, Li S, Qiu C, Gui L. Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review. The American Journal of Emergency Medicine. 2016 Dec 1;34(12):2432-9.
11. Hunter SB, Rutter CM, Ober AJ, Booth MS. Building capacity for continuous quality improvement (CQI): A pilot study. Journal of substance abuse treatment. 2017 Oct 1;81:44-52.
12. Geraty S. Adverse event registry analysis of an EMS system in a low resource setting: a descriptive study.
13. O’Hara R, Johnson M, Siriwardena AN, Weyman A, Turner J, Shaw D, Mortimer P, Newman C, Hirst E, Storey M, Mason S. A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. Journal of health services research & policy. 2015 Jan;20(1_suppl):45-53.
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16. Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health affairs. 2013 Feb 1;32(2):223-31.
17. Troyer L, Brady W. Barriers to effective EMS to emergency department information transfer at patient handover: a systematic review. The American Journal of Emergency Medicine. 2020 Jul 1;38(7):1494-503.
18. World Health Organization. Developing policies to prevent injuries and violence: guidelines for policy-makers and planners. World Health Organization; 2006.
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24. Wilson BR, Woodrow A. Patient Safety in Emergency Medical Services. InContemporary Topics in Patient Safety-Volume 2 2023 Mar 26. IntechOpen.
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26. Thomas D, Graham LA, Wright TJ, Almeida R, Blomberg RD, Benlemlih M. Characterizing Ambulance Driver Training in EMS Systems. United States. National Highway Traffic Safety Administration. Office of Behavioral Safety Research; 2019 Dec 1.
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30. Alshammari HS, Alshammari AF, Alshammari BF, Alhmshe AS, Alshammari TA, Al-Muhayfer AF, Almathal BF, Alrashdi ST, Alrashidi TM, Al Rashidi WH, Al-Rashidi AF. Multidisciplinary Collaboration In Emergency Medical Services. Journal of Positive Psychology and Wellbeing. 2022;6(3):695-721.
31. Wehbi NK, Wani R, Yang Y, Wilson F, Medcalf S, Monaghan B, Adams J, Paulman P. A needs assessment for simulation-based training of emergency medical providers in Nebraska, USA. Advances in Simulation. 2018 Dec;3:1-9.
32. Newgard CD, Zive D, Jui J, Weathers C, Daya M. Electronic versus manual data processing: evaluating the use of electronic health records in out‐of‐hospital clinical research. Academic Emergency Medicine. 2012 Feb;19(2):217-27.
33. Laub N, Agarwal AK, Shi C, Sjamsu A, Chaiyachati K. Delivering urgent care using telemedicine: insights from experienced clinicians at academic medical centers. Journal of General Internal Medicine. 2022 Mar;37(4):707-13.
34. Holmström IK, Kaminsky E, Lindberg Y, Spangler D, Winblad U. Registered nurses' experiences of using a clinical decision support system for triage of emergency calls: a qualitative interview study. Journal of advanced nursing. 2020 Nov;76(11):3104-12.
35. Barger LK, Runyon MS, Renn ML, Moore CG, Weiss PM, Condle JP, Flickinger KL, Divecha AA, Coppler PJ, Sequeira DJ, Lang ES. Effect of fatigue training on safety, fatigue, and sleep in emergency medical services personnel and other shift workers: a systematic review and meta-analysis. Prehospital emergency care. 2018 Feb 15;22(sup1):58-68.
36. Biquet JM. Patient safety in medical humanitarian action: medical error prevention and management (Doctoral dissertation, Université de Lyon; Université de Genève).
37. Bijani M, Abedi S, Karimi S, Tehranineshat B. Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC emergency medicine. 2021 Dec;21:1-2.
38. Sinnott C, Georgiadis A, Park J, Dixon-Woods M. Impacts of operational failures on primary care physicians’ work: a critical interpretive synthesis of the literature. The Annals of Family Medicine. 2020 Mar 1;18(2):159-68.
39. Wästerhed J, Ekenberg E, Hagiwara MA. Ambulance nurses’ experiences as the sole caregiver with critical patients during long ambulance transports: an interview study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2024 Jan 23;32(1):6.
40. Vahabi M. The impact of health communication on health‐related decision making: A review of evidence. Health Education. 2007 Jan 2;107(1):27-41.
41. Glenn M, Zoph O, Weidenaar K, Barraza L, Greco W, Jenkins K, Paode P, Fisher J. State regulation of community paramedicine programs: a national analysis. Prehospital emergency care. 2018 Mar 4;22(2):244-51.
42. Mariner WK, Miller FH. Medical error reporting: professional tensions between confidentiality & liability. Massachusetts Health Policy Forum.
43. Kakria P, Tripathi NK, Kitipawang P. A real‐time health monitoring system for remote cardiac patients using smartphone and wearable sensors. International journal of telemedicine and applications. 2015;2015(1):373474.
44. Getahun B, Nkosi ZZ. Satisfaction of patients with directly observed treatment strategy in Addis Ababa, Ethiopia: a mixed-methods study. PLoS One. 2017 Feb 9;12(2):e0171209.
45. Shankar KN, Bhatia BK, Schuur JD. Toward patient-centered care: a systematic review of older adults’ views of quality emergency care. Annals of emergency medicine. 2014 May 1;63(5):529-50.
46. Phillips TA. Attitudes and Perceptions of Emergency Medical Service Providers' Role in Educating Patients: A Cross-Sectional Survey.
47. Reay G, Norris JM, Nowell L, Hayden KA, Yokom K, Lang ES, Lazarenko GC, Abraham J. Transition in care from EMS providers to emergency department nurses: a systematic review. Prehospital emergency care. 2020 May 3;24(3):421-33.
48. Ryan BJ, Franklin RC, Burkle Jr FM, Aitken P, Smith E, Watt K, Leggat P. Reducing disaster exacerbated non-communicable diseases through public health infrastructure resilience: perspectives of Australian disaster service providers. PLoS currents. 2016 Dec 21;8.
49. Thim S, Henriksen TB, Laursen H, Schram AL, Paltved C, Lindhard MS. Simulation-based emergency team training in pediatrics: a systematic review. Pediatrics. 2022 Apr 1;149(4):e2021054305.
50. Hsu HC, Lin CH, Hsieh CC, Fang PH, Shih WT, Liu WC, Chi CH, Shih HI. Developing a Complex Simulation Training Program for Emergency Medical Services Paramedics Using a High-Fidelity Simulation Model. Journal of Medical Education. 2016 Dec 1;20(4):296-307.
51. Stefos KA, Nable JV. Implementation of a high-performance cardiopulmonary resuscitation protocol at a collegiate emergency medical services program. Journal of American College Health. 2016 May 18;64(4):329-33.
52. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012 Jul 24;79(4):306-13.
53. Patterson PD, Higgins JS, Van Dongen HP, Buysse DJ, Thackery RW, Kupas DF, Becker DS, Dean BE, Lindbeck GH, Guyette FX, Penner JH. Evidence-based guidelines for fatigue risk management in emergency medical services. Prehospital emergency care. 2018 Feb 15;22(sup1):89-101.
54. Ahmed Z, Mohamed K, Zeeshan S, Dong X. Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine. Database. 2020;2020:baaa010.
55. Wahl B, Cossy-Gantner A, Germann S, Schwalbe NR. Artificial intelligence (AI) and global health: how can AI contribute to health in resource-poor settings?. BMJ global health. 2018 Aug 1;3(4):e000798.
56. Rak RR. Internet of healthcare (law): privacy and data protection aspects in an internet of everything.
57. Kristiansen T, Søreide K, Ringdal KG, Rehn M, Krüger AJ, Reite A, Meling T, Næss PA, Lossius HM. Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury. 2010 May 1;41(5):444-52.
58. Jaeger PT, Shneiderman B, Fleischmann KR, Preece J, Qu Y, Wu PF. Community response grids: E-government, social networks, and effective emergency management. Telecommunications Policy. 2007 Nov 1;31(10-11):592-604.
59. Munjal KG, Margolis GS, Kellermann AL. Realignment of EMS reimbursement policy: new Hope for patient-centered out-of-hospital care. JAMA. 2019 Jul 23;322(4):303-4.
2. Hanson CS. Drivers of Emergency Medical Services (EMS) Utilization in the United States in 2019–2020. Northcentral University; 2022.
3. Bashiri A, Savareh BA, Ghazisaeedi M. Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges. Clinical and Experimental Emergency Medicine. 2019 Dec;6(4):288.
4. Brice JH, Studnek JR, Bigham BL, Martin-Gill C, Custalow CB, Hawkins E, Morrison LJ. EMS provider and patient safety during response and transport: proceedings of an ambulance safety conference. Prehospital Emergency Care. 2012 Jan 1;16(1):3-19.
5. Donaldson, L., & Philip, P. (2004). Patient safety: a global priority. Bulletin of the World Health Organization, 82, 892-892.
6. Hunt DF, Bailey J, Lennox BR, Crofts M, Vincent C. Enhancing psychological safety in mental health services. International journal of mental health systems. 2021 Dec;15:1-8.
7. Carter AJ, Jensen JL, Petrie DA, Greene J, Travers A, Goldstein JP, Cook J, Fidgen D, Swain J, Richardson L, Cain E. State of the evidence for emergency medical services (EMS) care: the evolution and current methodology of the prehospital evidence-based practice (PEP) program. Healthcare Policy. 2018 Aug;14(1):57.
8. Weaver MD, Wang HE, Fairbanks RJ, Patterson D. The association between EMS workplace safety culture and safety outcomes. Prehospital emergency care. 2012 Jan 1;16(1):43-52.
9. Carne B, Kennedy M, Gray T. Crisis resource management in emergency medicine. Emergency Medicine Australasia. 2012 Feb;24(1):7-13.
10. Chen C, Kan T, Li S, Qiu C, Gui L. Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: a literature review. The American Journal of Emergency Medicine. 2016 Dec 1;34(12):2432-9.
11. Hunter SB, Rutter CM, Ober AJ, Booth MS. Building capacity for continuous quality improvement (CQI): A pilot study. Journal of substance abuse treatment. 2017 Oct 1;81:44-52.
12. Geraty S. Adverse event registry analysis of an EMS system in a low resource setting: a descriptive study.
13. O’Hara R, Johnson M, Siriwardena AN, Weyman A, Turner J, Shaw D, Mortimer P, Newman C, Hirst E, Storey M, Mason S. A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. Journal of health services research & policy. 2015 Jan;20(1_suppl):45-53.
14. Scott BK, Miller GT, Fonda SJ, Yeaw RE, Gaudaen JC, Pavliscsak HH, Quinn MT, Pamplin JC. Advanced digital health technologies for COVID-19 and future emergencies. Telemedicine and e-Health. 2020 Oct 1;26(10):1226-33.
15. Atack L, Maher J. Emergency medical and health providers' perceptions of key issues in prehospital patient safety. Prehospital emergency care. 2010 Jan 1;14(1):95-102.
16. Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health affairs. 2013 Feb 1;32(2):223-31.
17. Troyer L, Brady W. Barriers to effective EMS to emergency department information transfer at patient handover: a systematic review. The American Journal of Emergency Medicine. 2020 Jul 1;38(7):1494-503.
18. World Health Organization. Developing policies to prevent injuries and violence: guidelines for policy-makers and planners. World Health Organization; 2006.
19. World Health Organization. Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization; 2021 Aug 3.
20. Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An integrative systematic review of promoting patient safety within prehospital emergency medical services by paramedics: A role theory perspective. Journal of Multidisciplinary Healthcare. 2024 Dec 31:1385-400.
21. Dekker S. Patient safety. A human factors approach. 2011:2011.
22. Hogan AN, Rosenberger R, Fowler RL. Emergency care regionalization. Emergency Medical Services: Clinical Practice and Systems Oversight. 2021 Aug 27;2:32-42.
23. Keebler JR, Lazzara EH, Misasi P, editors. Human factors and ergonomics of prehospital emergency care. CRC Press; 2017 Mar 31.
24. Wilson BR, Woodrow A. Patient Safety in Emergency Medical Services. InContemporary Topics in Patient Safety-Volume 2 2023 Mar 26. IntechOpen.
25. Ilkka L. Emergency medical services (EMS) in Finland: national data management as a path to better prehospital care (Doctoral dissertation, Itä-Suomen yliopisto).
26. Thomas D, Graham LA, Wright TJ, Almeida R, Blomberg RD, Benlemlih M. Characterizing Ambulance Driver Training in EMS Systems. United States. National Highway Traffic Safety Administration. Office of Behavioral Safety Research; 2019 Dec 1.
27. Tsao K, Browne M. Culture of safety: A foundation for patient care. InSeminars in pediatric surgery 2015 Dec 1 (Vol. 24, No. 6, pp. 283-287). WB Saunders.
28. Zonsius MC, Milner KA. Continuous quality improvement. Research for advanced practice nurses: from evidence to practice. 4th ed. New York: Springer Publishing Company. 2021 Feb 17:71-90.
29. McFadden KL, Lee JY, Gowen III CR, Sharp BM. Linking quality improvement practices to knowledge management capabilities. Quality Management Journal. 2014 Jan 1;21(1):42-58.
30. Alshammari HS, Alshammari AF, Alshammari BF, Alhmshe AS, Alshammari TA, Al-Muhayfer AF, Almathal BF, Alrashdi ST, Alrashidi TM, Al Rashidi WH, Al-Rashidi AF. Multidisciplinary Collaboration In Emergency Medical Services. Journal of Positive Psychology and Wellbeing. 2022;6(3):695-721.
31. Wehbi NK, Wani R, Yang Y, Wilson F, Medcalf S, Monaghan B, Adams J, Paulman P. A needs assessment for simulation-based training of emergency medical providers in Nebraska, USA. Advances in Simulation. 2018 Dec;3:1-9.
32. Newgard CD, Zive D, Jui J, Weathers C, Daya M. Electronic versus manual data processing: evaluating the use of electronic health records in out‐of‐hospital clinical research. Academic Emergency Medicine. 2012 Feb;19(2):217-27.
33. Laub N, Agarwal AK, Shi C, Sjamsu A, Chaiyachati K. Delivering urgent care using telemedicine: insights from experienced clinicians at academic medical centers. Journal of General Internal Medicine. 2022 Mar;37(4):707-13.
34. Holmström IK, Kaminsky E, Lindberg Y, Spangler D, Winblad U. Registered nurses' experiences of using a clinical decision support system for triage of emergency calls: a qualitative interview study. Journal of advanced nursing. 2020 Nov;76(11):3104-12.
35. Barger LK, Runyon MS, Renn ML, Moore CG, Weiss PM, Condle JP, Flickinger KL, Divecha AA, Coppler PJ, Sequeira DJ, Lang ES. Effect of fatigue training on safety, fatigue, and sleep in emergency medical services personnel and other shift workers: a systematic review and meta-analysis. Prehospital emergency care. 2018 Feb 15;22(sup1):58-68.
36. Biquet JM. Patient safety in medical humanitarian action: medical error prevention and management (Doctoral dissertation, Université de Lyon; Université de Genève).
37. Bijani M, Abedi S, Karimi S, Tehranineshat B. Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC emergency medicine. 2021 Dec;21:1-2.
38. Sinnott C, Georgiadis A, Park J, Dixon-Woods M. Impacts of operational failures on primary care physicians’ work: a critical interpretive synthesis of the literature. The Annals of Family Medicine. 2020 Mar 1;18(2):159-68.
39. Wästerhed J, Ekenberg E, Hagiwara MA. Ambulance nurses’ experiences as the sole caregiver with critical patients during long ambulance transports: an interview study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2024 Jan 23;32(1):6.
40. Vahabi M. The impact of health communication on health‐related decision making: A review of evidence. Health Education. 2007 Jan 2;107(1):27-41.
41. Glenn M, Zoph O, Weidenaar K, Barraza L, Greco W, Jenkins K, Paode P, Fisher J. State regulation of community paramedicine programs: a national analysis. Prehospital emergency care. 2018 Mar 4;22(2):244-51.
42. Mariner WK, Miller FH. Medical error reporting: professional tensions between confidentiality & liability. Massachusetts Health Policy Forum.
43. Kakria P, Tripathi NK, Kitipawang P. A real‐time health monitoring system for remote cardiac patients using smartphone and wearable sensors. International journal of telemedicine and applications. 2015;2015(1):373474.
44. Getahun B, Nkosi ZZ. Satisfaction of patients with directly observed treatment strategy in Addis Ababa, Ethiopia: a mixed-methods study. PLoS One. 2017 Feb 9;12(2):e0171209.
45. Shankar KN, Bhatia BK, Schuur JD. Toward patient-centered care: a systematic review of older adults’ views of quality emergency care. Annals of emergency medicine. 2014 May 1;63(5):529-50.
46. Phillips TA. Attitudes and Perceptions of Emergency Medical Service Providers' Role in Educating Patients: A Cross-Sectional Survey.
47. Reay G, Norris JM, Nowell L, Hayden KA, Yokom K, Lang ES, Lazarenko GC, Abraham J. Transition in care from EMS providers to emergency department nurses: a systematic review. Prehospital emergency care. 2020 May 3;24(3):421-33.
48. Ryan BJ, Franklin RC, Burkle Jr FM, Aitken P, Smith E, Watt K, Leggat P. Reducing disaster exacerbated non-communicable diseases through public health infrastructure resilience: perspectives of Australian disaster service providers. PLoS currents. 2016 Dec 21;8.
49. Thim S, Henriksen TB, Laursen H, Schram AL, Paltved C, Lindhard MS. Simulation-based emergency team training in pediatrics: a systematic review. Pediatrics. 2022 Apr 1;149(4):e2021054305.
50. Hsu HC, Lin CH, Hsieh CC, Fang PH, Shih WT, Liu WC, Chi CH, Shih HI. Developing a Complex Simulation Training Program for Emergency Medical Services Paramedics Using a High-Fidelity Simulation Model. Journal of Medical Education. 2016 Dec 1;20(4):296-307.
51. Stefos KA, Nable JV. Implementation of a high-performance cardiopulmonary resuscitation protocol at a collegiate emergency medical services program. Journal of American College Health. 2016 May 18;64(4):329-33.
52. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012 Jul 24;79(4):306-13.
53. Patterson PD, Higgins JS, Van Dongen HP, Buysse DJ, Thackery RW, Kupas DF, Becker DS, Dean BE, Lindbeck GH, Guyette FX, Penner JH. Evidence-based guidelines for fatigue risk management in emergency medical services. Prehospital emergency care. 2018 Feb 15;22(sup1):89-101.
54. Ahmed Z, Mohamed K, Zeeshan S, Dong X. Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine. Database. 2020;2020:baaa010.
55. Wahl B, Cossy-Gantner A, Germann S, Schwalbe NR. Artificial intelligence (AI) and global health: how can AI contribute to health in resource-poor settings?. BMJ global health. 2018 Aug 1;3(4):e000798.
56. Rak RR. Internet of healthcare (law): privacy and data protection aspects in an internet of everything.
57. Kristiansen T, Søreide K, Ringdal KG, Rehn M, Krüger AJ, Reite A, Meling T, Næss PA, Lossius HM. Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury. 2010 May 1;41(5):444-52.
58. Jaeger PT, Shneiderman B, Fleischmann KR, Preece J, Qu Y, Wu PF. Community response grids: E-government, social networks, and effective emergency management. Telecommunications Policy. 2007 Nov 1;31(10-11):592-604.
59. Munjal KG, Margolis GS, Kellermann AL. Realignment of EMS reimbursement policy: new Hope for patient-centered out-of-hospital care. JAMA. 2019 Jul 23;322(4):303-4.
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Sep 20, 2024
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PATIENT SAFETY AND QUALITY IMPROVEMENT IN EMERGENCY MEDICAL SERVICES: CURRENT PRACTICES AND FUTURE DIRECTIONS. (2024). Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 1535-546. https://doi.org/10.53555/5vh38e40
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Author Biographies
Dr Vaibhav. C. Dave
Assistant Professor, Musculoskeletal and Sports science, Madhav University, Rajasthan, India
Priyadarsini. P. G
Research Scholar Department of Commerce PSG College of Arts & Science Coimbatore-641014
Dr. Prachi Oza
Musculoskeletal and Sports science Assistant Professor Madhav University
Dr Sukanta Bandyopadhyay
Associate Professor, Dept. of Biochemistry, Rama Medical College Hospital & Research Centre, Kanpur, India,
Dr. Seema Yadav
Principal, College of Nursing. Sarojini Naidu Medical College, Agra, UP.
How to Cite
PATIENT SAFETY AND QUALITY IMPROVEMENT IN EMERGENCY MEDICAL SERVICES: CURRENT PRACTICES AND FUTURE DIRECTIONS. (2024). Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 1535-546. https://doi.org/10.53555/5vh38e40